COMPLIANCE INFO - Laserfiche WebLink

Home Browse Search

WORK ORDEMERVICE AGREEMENT Evergreen Environmental Services N° 667-116 dedicated to the protection of the environment To Schedule a pickup,call Send payment to: Sales Order �—1 S- 800-972-5284 Evergreen Oil,Inc. 6880 Smith Ave.,Newark,CA EPA#CAD982413262 Dept.LA 23234 : ' Lt-13 1 16540 S.Smt Pedro St.,Canon,CA EPA#CAD982413262 Pasadena,CA 91185-3234 Date GENERATOIVJ'OB LOCATION BILLING INFORMATION hnc NAME CASH(J CHECK p S, � ADDRESS ADDRESS CUSTOME R CODE NO. Nd G - 2-J t-Q., o CIT ' STATE ZIP CO. CITY STATE ZIP CO. PO# HONE NO. PHONE NO. PROFILE NO. I CUSTOAIER EPA ID NO. PRODUCT WCODEASTE MANIFEST ODE QUANTITY UNITS PRICE AMOUNT C Used oil,ATon-RCRA Hazardous Lubricating CA22 )—t)0-176 A)e I?-I' Gal. Waste,Liquid Industrial CA22I Gal. Used AutonroNs�Amifretzy Non-RCRAHaz Jd CA134 Gal, Waste Liquid RQ\Nada Cant+ustibk Llqufd,N.O.S.NA C FDeA221IlF�2 Gal. 1993 nt{Oil eoatamtnued a9ds hslo ens Oil&Water,Nott-RCRA Hazardous Waste Liquid CA223 Gal. Non Hazardous Water Gal, Waste Solids and Sludges Gal. Nash Out Each Pressure Washer/Steam Gleaner Day Transportation Hrs. Fuel Surcharge % Glycol Bulk 501511S.ecify Product Gal. Glycol Bulk oncispecifyProduct Gal TEST:ZCI.D Tech 4000Z�=ppnt ❑Clor D Tech 1000 Pass ❑Fail Retain sample# Total Charges i Require (� Field Service Work Description: i Other: t Other: %E,v,,,rgr,en Consolidated Manifest DRIVER C KLIST Oil,Inc. Evergreen Oil,Inc.-Davis Evergreen Oil,Inc.-Fresno ❑•1 erne In 'lime Out SmithAve. ❑ Road ❑4I39N.Valentine Tmtidllrum Properly Labeled Newark,CA 94560 Davis,CA 95616 Fresno,CA 93722 P Y CAD980887418 CAD982446874 CAD982446882 ❑Accumulation Start Dale Marked Evergreen Env.Svc. ❑ �rrtaalnc ........_.... -------------Satiahllib El House Keeping-T.mk/Drmn Clean ............................--......_....16604 _ .S.San Pedro .... ..74 AWVestBetteravia 0 Other Services Checked:O Oil;i7-Piltcrs/Dntnis;'0 Antifree7c Carson,CA 90746 Santa Maria,CA 93454 CAD98169642 CAD982446858 0 Caned in other services needed❑011, ❑ Filters/Drums, Antifreeze Source: Collection Station ®Government Generator certifies that it has established a program to reduce the volume or quantity&toxicity of rite hazardous waste to the degree determined by ®Marine ® Agricultural p Industdal generator to be economically practicable. I hereby certify that I have rend and lnnve the authority to bind the above listed generator to the terms on the reverse side of this form. IMPORTANT NOTICE REGARDING THE DISPOSMON OF YOUR OIL. 3 Per California Healtli and Safety Code Section 25250.9,Evergreen hereby advises customer that customer's shipment of used oil may be 1 transported to a facility that is required to comply with federal regulations applicable to management of used oil,but that is not required to I comply with the more stringent requirements applicable to hazardous waste management facilities.California facilities that handle or process used .ii are required to meet those more stringent requirements,and some out-of-state facilities that process used oil also meet those requirements, i I ese in Jude more stringent leak detection and prevention requirements,engineering certifications of tank integrity,and financial assurances for closure d accidental releases.It is lawful to send used oil to out-of-state facilities that comply only with f era[used oil management standards and no t ese more stringent requirements.This notification is for information purposes only. i '4t' 'I'7 / 441 t I D er Signature Print Name Route# Date ner tors Signature Print Name Date White Copy=Customer Copy-Pink&Yellow Copy=Office Use-Green Copy=Attach to manifest-Golden Copy=Driver Copy